Introduction
Healthcare systems globally struggle to provide care for patients with COVID-19. The role of surgical procedures is poorly defined in pandemic response. We performed a thorough epidemiology of surgical procedures in patients admitted with COVID-19 to our hospital system.
Methods
We retrospectively studied the hospital course of 1,260 patients admitted to 5 hospitals for management of COVID-19, from March 1 to October 6, 2020. Major procedures were those performed in the operating room. Class I minor procedures were those typically performed by surgeons including chest tubes, surgical drains/incisions unrelated to major procedures, extracorporeal membrane oxygenation cannulations, gastrostomy tubes, surgical airways, and hemodialysis/tunneled central lines. Class II minor procedures were those performed by surgeons and nonsurgeons including nontunneled central lines, vascular sheaths, and pacemakers. Patients were stratified based on the 8-point World Health Organization (WHO) COVID-19 severity scale (1-2-nonhospitalized, 3-room air, 4-nasal cannula/facemask oxygen, 5-high-flow nasal cannula/noninvasive positive-pressure ventilation, 6-mechanical ventilation, 7-level 6 plus signs of organ failure [eg: hemodialysis], and 8-death). Proportions were compared using chi-squared analysis.
Results
Surgical procedures were provided to hospitalized patients with all disease severities (3-8); 950 patients (75.4%) had severity 3/4/5, 174 (13.8%) had severity 6/7/8, and 136 (10.8%) were missing severity data. Compared with severity 3/4/5, more patients of severity 6/7/8 underwent a class I procedure (21.8% vs 2.00%, p<0.0001) and class I or II (56.90% vs 3.47%, p<0.0001) procedure. Major procedures occurred in 20/1,260 (1.59%) patients.
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Conclusion
Surgical services are important in treating COVID-19 patients and correlate with disease severity.